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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1913198

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Case Details

VAERS ID: 1913198 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Airway peak pressure increased, Asthenia, Back pain, Bradycardia, Cardiac output decreased, Cardiac tamponade, Chemotherapy, Chest pain, Death, Debridement, Diarrhoea, Dyspnoea, Endotracheal intubation, Epithelioid sarcoma, Exploratory operation, Fatigue, Fluid retention, General symptom, Haemofiltration, Hypotension, Influenza virus test negative, Intracardiac mass, Lactic acidosis, Loss of personal independence in daily activities, Low lung compliance, Multiple organ dysfunction syndrome, Neoplasm malignant, Oedema, Oropharyngeal pain, Pericardial excision, Pericardial rub, Pneumonia, Pulmonary oedema, Pyrexia, SARS-CoV-2 test negative, Sedation, Streptococcus test negative, Tachycardia, Tumour excision
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-01
   Days after onset: 91
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 30 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None known
Current Illness: unknown
Preexisting Conditions: none
Allergies: No known allergies
Diagnostic Lab Data: Admitted to local HCF 10/30/21. See the following from her death note summary related to hospital course: Pt is a 13 y.o. female admitted for Left atrial mass and has been hospitalized for 30 days. she had her left atrial mass resection on 11/11/21, pericardial window creation, and mediastinal exploration with debridement. Her mass continued to grow and increase in size and Rhee invading the left atrium and possibly the right atrium along with creation of tamponade physiology on the ventricles. She was started on chemotherapy by hematology team, Nephrology team started her her on CRRT since she developed acute kidney injury along was multi organ failure and severe lactic acidosis. Patient was on multiple inotropics support with progressively increasing inotropics support epinephrine up to 0.3 micrograms/kilogram per minute, norepinephrine up to 0.3 micrograms/kilogram per minute along with 2 milliunits per kg per minute vasopressin. Over the past 48 hours prior to patient staff she was getting multiple fluid boluses and she was few L positive every day with severe 3rd spacing and progressively worsening cardiac output. She has had evidence of progressive tamponade physiology despite aggressive chemotherapy. she remained intubated and sedated with extremely high lung peak pressures and very poor compliance with severe pulmonary edema. On 12/1/2021 family expressed the wishes of stop giving fluids to her since she looks very edematous, parents understand that this will lead to cardiac arrest and ending her life within the next few hours, father expressed he is willing to do everything for her but he wants to end her suffering, mom and dad were at the bedside, IV fluid replacement was stopped. Patient vasopressin was weaned along with other inotropic support, family agreed on extubating the patient so that they can spend some time with her prior to the off. Patient continue to progressively having low cardiac output, hypotension and bradycardia, time of death was 7:00 a.m..
CDC Split Type:

Write-up: Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service.

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